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W <br /> , UIEnvironmental Health Department <br /> C O U h,I T Y _. .. . <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINOR violations noted in the " Notice to Comply" in the attached Inspection Report must be corrected within 30 days of <br /> receipt of this inspection . This certification form must be submitted to the Environmental Health Department ( EHD) address <br /> at the top of this form within 30 days of receipt of the Inspection Report, HSC 25404 . 1 . 2(c)( 1 ) <br /> All corrections to other violations noted in the attached Inspection Report ( IR) or Continuation Form , or disputes to any <br /> violations, are to be submitted using this certification and returned to EHD within 30 days unless otherwise specified in the <br /> Inspection Report, HSC 25185(c)(3) <br /> Note : All EHD staff time associated with failing to comply by the above noted dates will be <br /> billed at the current hourly rate. <br /> For this certification to be complete , the operator of the site must include: <br /> A statement documenting what corrective actions were taken or will be taken for each violation <br /> Copies of sample results/manifests/training records/other appropriate paperwork, and/or photos verifying <br /> corrections <br /> Operator's certification <br /> Inspection Date : April 10 , 2019 Inspected By : CLAUDIA MURO <br /> Facility Address , 18351 E MAIN ST , LINDEN CERS ID , 10181539 <br /> I certify under penalty of law that: <br /> 1 . 1 have corrected the violations specified in the Inspection Report faom the above-mentioned inspection date . <br /> 2 . 1 have personally examined the following documentation submitted as proof of compliance FOR EACH VIOLATION <br /> and I believe the information to be true, accurate , and complete : j <br /> Photosy Paperwork Statement <br /> 3 . 1 am authorized to submit this certification on behalf of the Respondent. <br /> 4 . 1 am aware that there are significant penalties for submitting false information , including the possibility of a fine <br /> and/or imprisonment for known violations . ( HSC 25191 ) ( � <br /> Name : 4 rvL. Title :.Gh4 J v Pr V' t S d <br /> Signature : _ Date : — l <br /> 1868 E . Hazelton Avenue I Stockton , California 95205 1 T 209 468- 3420 1 F 209 464 -0138 1 www. sjcehd . com <br />